SAGINAW, MI — In the Sterile Processing Department at St. Mary's of Michigan hospital in Saginaw, technicians work day and night scrubbing, spraying, washing, counting, sorting, sterilizing and storing tens of thousands of surgical instruments each month.

Carla Musielak, sterile processing manager, said as of mid-February the department employed 21, with three openings.

Musielak gave The Saginaw News a tour of the department beginning at the end where tools that have already been washed and sterilized are stored and ready for the next procedure, and working backward through the multi-step process all reusable surgical instruments undergo between uses.

She said about 87 percent of the staff is nationally certified in sterile processing, pointing to a wall of certificates. Employees have two years from the time of employment to become certified, she said.

"I had this wall made just to show them we were proud," Musielak said. "...It just forces them to keep active and up-to-date."

Around a corner, the sterile area of the department features trays of ready-to-use instruments lined up on shelves. It's neat and orderly.

"This is the finished room. This is the stuff that's sterile, ready to go to an OR room," she said.

Musielak said she started the tour in the cleanest area of the department and ended the tour in the dirtiest area so as not to track contaminants from the "dirty side," where contaminated surgical equipment arrives, to the "clean side," where the final steps of the sterilization process take place.

The department is full of machines, some of which look like and appear to function similarly to dishwashers. There are ultrasonic machines, machines that sanitize with steam and machines that sanitize with hydrogen peroxide.

A clean elevator transports carts — which are cleaned by a machine of their own — carrying trays of sterile instruments up to the operating room.

"That opens right into the middle of the surgery suite," Musielak said.

A separate elevator brings used instruments down to the Sterile Processing Department to go through the process again.

Musielak said every instrument must be washed before it can be sterilized because material such as bone cannot be sterilized. Everything must be done according to the manufacturers' recommendations.

The technicians are meticulous.

"They have to look at every little joint, every little thread. They have to make sure, you know, is there anything under this screw, because we don't want to send it to the next patient. So, it's really a tedious job over there on that side," Musielak said, referencing the "dirty side" of the department where the process begins.

Musielak said the department processes 13,000 to 15,000 trays of instruments every three months, or about 89,000 individual instruments per month.

"It's busy around the clock. There's always something to do," she said.

Musielak walked into the hallway and through a separate door to the department's "dirty side," where the work begins.

"These are the (ultra)sonics, so it's kind of like a ring cleaner, but on a bigger scale. We want to jiggle any bone, any debris in instruments free," she said, pointing out the large machines. "Here's some orthopedic tools that are waiting to go in here."